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Multidisciplinary Approach Improves Pediatric Surgery Outcomes

March 2015 - Surgery

Birth defects are the leading cause of mortality and morbidity in children. The proportion of infant mortality due to birth defects was 21% in 2010 1 , and birth defects account for about 12% of all pediatric hospitalizations.2, 3 Some birth defects are relatively minor, but many are complex, involving more than one organ system, and require a multidisciplinary approach to corrective care. Some congenital abnormalities require immediate attention in the newborn period while others can be addressed later in childhood.

University of Minnesota Masonic Children’s Hospital’s Division of Pediatric Surgery brings a wide breadth of surgical care and a cross-disciplinary approach to the treatment of these difficult conditions. In working with children with a range of conditions, the pediatric surgeons make use of the most advanced surgical options, including laparoscopic, robotic, and traditional open surgical techniques. Their approach focuses on improving and maintaining long-term quality of life.

The hospital’s pediatric surgeons have also been recognized for their outstanding research into solid pediatric malignancies, necrotizing enterocolitis, infections in surgically implanted devices, and the use of simulation for medical students as an adjunct to the operating room.

UMMCH-lobby-063201-4C 974x650
— University of Minnesota Masonic Children's Hospital lobby

A Leading Chest-Wall Deformity Practice

Chest-wall deformities affect about 1% of the population. 4 The most common chest-wall deformities are pectus excavatum (88%) and pectus carinatum (5%).5 While some patients with relatively minor malformations maintain a very high quality of life, many patients with chest-wall deformities experience limitations, such as shortness of breath with exercise, impairments in pulmonary and/or cardiac function, early exercise fatigue and intolerance, and social isolation and embarrassment.6, 7 Treatment is generally undertaken during the teenage years.

The chest-wall deformity practice at University of Minnesota Masonic Children’s Hospital is one of the largest in the United States. For pectus excavatum, the practice offers both the minimally invasive Nuss procedure and the traditional modified Ravitch procedure. New techniques for controlling post-operative pain have helped reduce the length of hospital stays. A typical hospital stay is now 2 to 4 days. For pectus carinatum, chest-wall bracing is widely employed. The ideal age for bracing is around 13 to 15 years of age, and the brace is typically worn for about 2 years, similar to the amount of time for dental braces.

Minimally Invasive Options for Pediatric Surgery

Surgeons at University of Minnesota Masonic Children’s Hospital have helped pioneer laparoscopic options for pediatric surgery. They were among the first in the United States to conduct minimally invasive laparoscopic procedures on premature infants. Many such patients cannot be safely managed at other institutions because their low birth weight and small size. The hospital’s pediatric surgeons are also affiliated with the University of Minnesota Center for Minimally Invasive Surgery, one of the few places in the country that combines clinical practice, research, education, and specialized training in one location.

Pediatric laparoscopic surgery is available at the hospital for the following conditions: nephrectomy/partial nephrectomy, appendectomy, cholecystectomy, exploration for pain or tumor, gastrostomy tube placement, Nissen fundoplication, rectal resection and pull-through for Hirschsprung’s disease, splenectomy, drainage of empyema, and lung resection for tumor or congenital mass, among others.

References

1. Matthews TJ, MacDorman MF. Infant mortality statistics from the 2010 period linked birth/infant death data set. Natl Vital Stat Rep. 2013;62(8):1-26.

2. Colvin L, Bower C. A retrospective population-based study of childhood hospital admissions with record linkage to a birth defects registry. BMC Pediatr. 2009;9:32.

3. Yoon PW, et al. Contribution of birth defects and genetic diseases to pediatric hospitalizations. A population-based study. Arch Pediatr Adolesc Med. 1997;151(11):1096-1103.

4. Williams AM, Crabbe DC. Pectus deformities of the anterior chest wall. Paediatr Respir Rev. 2003;4(3):237-242.

5. Obermeyer RJ, Goretsky MJ. Chest wall deformities in pediatric surgery. Surg Clin North Am. 2012;92(3):669-684.

6. De Oliveira Carvalho PE, et al. Surgical interventions for treating pectus excavatum. Cochrane Database Syst. Rev. 014;10:CD008889.

7. Coelho Mde S, Guimarães Pde S. Pectus carinatum. J Bras Pneumol. 2007;33(4):463-474.

When to refer

As the only children’s hospital in Minnesota that is part of an academic health center, we provide patients with access to multiple services in one convenient location. The hospital is also home to one of the top 20 pediatric and surgical research programs in the United States.

Our goal, whenever possible, is to see your pediatric referral patient within 1 to 2 days, if requested.


University of Minnesota Masonic Children’s Hospital appointments:

612-365-6777 or 612-624-6962

Physician consultation, referral or appointment (all UMN Health locations):

888-KIDS-UMN (888-543-7866)


We treat the following:

• Birth defects (abdominal wall defects, anorectal malformations, hernias, gastrointestinal defects)

• Chest-wall deformities

• Hernias

• Any intestinal disorder in any age child

• Liver disease

• Lung disorders (congenital cystic adenoid malformation of the lung, congenital lobar emphysema, tumors)

• Portal vein hypertension

• Spleen disorders requiring removal

• Traumatic injuries

• Tumors (neuroblastomas, sarcomas, teratomas, Wilm’s tumor)

• Vascular anomalies

Collaborative Care

Our multidisciplinary care team includes physicians, nurse practitioners, social workers, nurses, psychologists, nutritionists, child family life specialists, and other professionals who are especially attuned to the medical and emotional needs of young people. We are committed to working with you to obtain the best possible outcome for your patients and their families.

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